ADA supports a centralized credentialing system for IHS

Washington — The ADA strongly supports a centralized system to credential licensed health care professionals interested in providing services at Indian Health Services facilities, ADA President-elect Joseph P. Crowley told the Senate Committee on Indian Affairs during his June 13 testimony.

The medical credentialing system provision is part of Senate bill 1250, the Restoring Accountability in the Indian Health Service Act of 2017. The bill is sponsored by Sen. John Hoeven, R-N.D., Senate Committee on Indian Affairs chair, and Senators John Barrasso, R-Wy., and John Thune, R-S.D. It calls for IHS to implement an agency-wide centralized credentialing system to credential licensed health care professionals who seek to provide health care services at any IHS facility.

Dr. Crowley

After meeting with current and former IHS officials, private sector dentists, and state dental associations who have had experience with the credentialing process at various IHS facilities, Dr. Crowley told legislators that the ADA believes a centralized credentialing system would benefit both practitioners and the IHS.

Right now, the credentialing process for dentists takes "8-12 hours of staff time and costs the program about $1,000 per applicant," and can also be an intimidating process for many applicants, Dr. Crowley said. He shared a 2012 example from the South Dakota Dental Association, which actively recruited IHS volunteers only to find that out of 70 applicants, only two ultimately became credentialed to volunteer. This prompted the dental organization to partner instead with a private charity organization that was not subject to the same credentialing constraints as those placed on federal facilities.

Dr. Crowley testified that many other federal agencies, including all five branches of the U.S. military, use the Centralized Credentials & Quality Assurance System, a web-based worldwide credentialing, privileging, risk management, and adverse actions application that supports medical personnel readiness. The ADA president elect also noted that the IHS itself has prioritized improving the credentialing process when it made quality improvement an agency priority last year.

In improving the oral health in tribal communities, the ADA is currently supporting the implementation of a 10 Year Health and Wellness Plan, which includes oral health and is designed to reduce oral disease by 50 percent among the Navajo tribal communities. The Navajo Nation is the largest reservation in the United States.

Centralizing the credentialing process and having more dentists available will enable greater community outreach, community education, and preventive services and will complement the ADA's efforts with the Community Dental Health Coordinator program, which by the end of 2017 will have over 100 graduates working in 21 states.

"This bill is intended to increase transparency and accountability, improve patient safety and care, and boost recruitment and retention of employees in the IHS," said Sen. Hoeven, who asked Rear Admiral Chris Buchanan, acting director, Indian Health Services, to work with the ADA on ways to streamline the credentialing process.

During her testimony, Victoria Kitcheyan, treasurer for the Winnebago Tribal Council and Great Plains Area Representative for the National Indian Health Board, said, "American Indian and Alaska Natives suffer some of the worst health disparities of all Americans. In some states, life expectancy is 20 years less [than other Americans]. With these statistics, it is unconscionable that some IHS-operated facilities continue to deliver a poor quality of care to our people… It is clear that management, recruitment, accountability and transparency are all still issues that need to be addressed, most of which are covered in the proposed legislation."